Twenty years ago, most people who contracted HIV quickly succumbed to AIDS-related illnesses. Today, better health care means that more HIV-positive people in the United States are living closer to a normal lifespan. Many health experts hope the same will soon be possible in Africa, as HIV drugs and treatment programs become more accessible. But no matter how effectively new anti-retroviral drugs can control symptoms, prevention is still vital.
With his firm handshake and sparkling eyes, Stephan seems much younger than his 45 years. And this Denver resident doesn't look like someone who's been HIV positive since the 1980s.
"It's going on 17 years, which is unusual, because I found out that I was positive at a time when the average lifespan, statistically, was 11 months. From date of diagnosis to death, was 11 months," he said.
Better anti-retroviral drugs saved Stephan's life. These days, he adds many HIV-positive Americans survive long enough to succumb to "normal" diseases of aging.
"We're now seeing a lot of HIV-positive people become victims of heart disease and, you know, the standard things that any person could get," he said.
To manage his condition, Stephan has become an expert in the treatment of HIV infection. He's a sought-after speaker at schools and health clinics, where he explains how to live with HIV, and how the virus isn't transmitted through handshakes or sneezes, but spreads when people have unprotected sex, or if injected drug users share needles.
Some in his audiences remain cavalier, saying that the chance of contracting HIV is so low, it will never happen to them, even if they do participate in risky behaviors. Besides, some with this attitude say, if they did become infected, they'd take the meds. So when people ask Stephan if the drugs have side effects, he has a ready answer.
"Oh, yes there are," he said. "Some of the side effects are extremely unpleasant. It depends on which drug you're on. The protease inhibitors, particularly, the one that I'm on, causes extreme diarrhea. When I say diarrhea, I'm talking purely watery, five or six times a day, explosive and in high volume. It's extremely unpleasant and it's sometimes quite uncontrollable. You can have accidents in public spaces, and that is very embarrassing and uncomfortable. Some of them cause nausea; some of them cause loss of appetite. And some of them have deadly side effects."
Statia, 21, knows about those side effects as well, because she's been HIV-positive since the age of 15. Statia has spoken at many public education forums, and she especially likes to talks with teens about the importance of practicing safe sex, even when passions run high.
"In the long run, it's worth it, because after all those feelings are over and that person's gone away, you're stuck, and you've got to live with it, and that's reality," she said.
And that's a message experts at the Centers for Disease Control would like more people to hear.
"The dilemma that we're facing in the field of HIV prevention is that we still see that there are around 40,000 new infections of HIV every year, which really is unacceptable," said CDC epidemiologist Lisa Lee, who is working to reduce those infection rates.
According to the CDC, new HIV cases in the United States peaked in the mid-1980s, at around 160,000 annually. Education campaigns have played a large part in bringing that rate down to 40,000, where it has remained for several years. Knowing that effective treatments are available gives Americans an incentive to learn their HIV status. Today, more than 600,000 Americans know that they are HIV-positive, and according to Dr. Lee, that knowledge makes them allies in preventing new infections.
"They basically want to do the right thing and keep their partner safe and actually do reduce their unsafe behavior dramatically in some cases, and in fact in most cases," she said.
More troublesome are the roughly 200,000 HIV-positive Americans who don't yet realize they're infected. Although this group represents only 25 percent of those who live with HIV, Dr. Lee says they account for two thirds of new infections. There are a number of reasons these people don't know their status. Requesting an HIV test can be intimidating, and AIDS educator Stephan observes that there's a high level of denial among people who choose risky behaviors. But Statia says it's better to "bite the bullet."
"It's just, a matter of actually taking the incentive and doing it, knowing what the consequences can be long and short term, and you're better off knowing than not," said Statia.
To make it easier for people to learn their true status, without the stigma of having to specifically ask for a test, the Centers for Disease Control recommends that HIV screenings be offered as a standard part of many medical checkups.